BIOFILMS IN CHRONIC WOUNDS: WHY YOUR WOUND ISN’T HEALING

If you have a wound that just won’t heal, despite using many bandages, creams, or attending numerous appointments, the issue might be something you’ve never heard of: biofilms.

Biofilms are a hidden yet very real reason why some wounds remain open for weeks, months, or even years. They are one of the biggest challenges to proper wound healing, especially in chronic cases like diabetic ulcers, pressure sores, and venous leg ulcers.

In this blog, we will explain what biofilms are, how they impact wound healing, and why debridement and the use of debriding dressings are key parts of treatment. No confusing medical terms, but just clear information to help you understand what’s happening with your wound and how to assist in its healing.

What Is Biofilm?

Think of a biofilm as a protective "slime shield" that bacteria create around themselves. These bacteria cluster together and make a sticky layer that sticks firmly to the wound bed. Once this slimy layer forms, it becomes very difficult to remove and almost impossible to treat with regular antibiotics or antiseptics.

Studies show that up to 90% of chronic wounds have biofilms. That shows how common they are and how serious a problem they can become.

How Do Biofilms Affect Healing?

Biofilms can stop your wound from healing properly, and here’s how:

• They shield harmful bacteria: Biofilms act like armor for bacteria, making them tough against your immune system and most treatments.
• They trigger constant inflammation: The body attempts to fight off the bacteria, which causes lasting inflammation. This keeps your wound stuck in the early stage of healing.
• They hinder tissue growth: New tissue struggles to grow if there’s a biofilm present in the way.
• They increase the risk of infection: Biofilms make infections harder to treat and increase the chances of recurrence.

In short, if your wound isn’t healing, biofilms might be the invisible culprit.

What Is Debridement, and Why Is It Important?

Debridement is a medical procedure that removes dead tissue, infected material, and biofilms from a wound. This cleaning process is essential for giving your wound a fresh start and creating an environment where new, healthy tissue can grow.

There are different types of debridement, including:

• Surgical or sharp debridement: A trained clinician uses a scalpel, curette, or scissors to quickly remove damaged tissue.
• Autolytic debridement: This method uses your body’s natural enzymes and moisture to break down dead tissue.
• Enzymatic debridement: It involves applying topical medications to digest unhealthy tissue.
• Mechanical debridement: This technique uses methods like wet-to-dry dressings or wound irrigation.
• Biological debridement: Also known as maggot therapy, this method uses sterilized larvae to eat away dead tissue.

No matter the method, the goal is the same: remove what’s preventing healing.

What Are Debriding Dressings?

Debriding dressings are special types of wound dressings. They gently remove slough, dead tissue, and biofilms over time. These dressings are a good option when frequent sharp debridement isn’t practical or possible.

Some of the most commonly used debriding dressings include:

• Hydrogel dressings: Keep the wound moist and soften dead tissue for easier removal.
• Alginate dressings: Made from seaweed, they absorb exudate and help lift out slough and biofilms.
• Honey-based dressings: Medical-grade honey can help break down biofilms and promote healing.
• Iodine or silver-containing dressings: These provide antimicrobial action to help reduce bacteria in biofilms.

Your healthcare provider will choose the best type of dressing based on your wound’s condition.

How Do You Know If Your Wound Has Biofilm?

Biofilms can’t be seen without special tools, but some signs indicate they might be there:

• A wound that appears moist but doesn’t heal for weeks
• A persistent foul odor
• Frequent or recurring infections
• A wound covered in yellow or gray slough
• Excess fluid or long-term inflammation

If your wound isn’t healing even with treatment, talk to your wound care provider about biofilms.

What Can You Do as a Patient?

Understanding biofilms and the importance of debridement can help you take control of your wound healing journey. Here’s what you can do:

• Attend all follow-up appointments for wound assessments and debridement.
• Don’t remove dressings early unless instructed, as some dressings need time to work.
• Watch for signs of infection, such as redness, warmth, or increased pain, and report them immediately.
• Manage underlying conditions, like diabetes or poor circulation, which can contribute to chronic wounds.

Stay consistent with your care plan, even if healing is slow. Persistence pays off.

Final Thoughts

Chronic wounds can be frustrating and discouraging, especially when it feels like nothing is working. The presence of biofilms might explain the delay, and thankfully, we now have the tools to manage them.

Debridement and debriding dressings are not just treatments; they are crucial steps in removing barriers to healing. By understanding their role, you are taking an important step in advocating for your health.

If you think your wound isn’t healing properly, discuss biofilms and their potential impact on your recovery with your healthcare provider. With the right approach, healing is not just possible, it is achievable.

If you have any questions about your wound care or treatment plan, don’t hesitate to reach out to your wound care team. You are not alone on this journey, and help is available.

Author

Jenna Wishnew Dr. Jenna Wishnew is a board-certified general surgeon with over a decade of experience serving the North Dallas community. Known for her compassionate, patient-centered care, she specializes in wound care and hyperbaric oxygen therapy (HBOT), currently serving as Medical Director at the Wound Care and Hyperbaric Center at Methodist Richardson Medical Center. Dr. Wishnew is a recognized leader in her field, earning two international awards for excellence in wound care. She also has extensive experience managing gastroparesis and Enterra Gastric Stimulators.